US evaluation of Poland syndrome

none6Alessio Mazzola, M.; Boccalini, S.; Fisci, E.; Rolla Bigliani, C.; Tagliafico, A.; Martinoli, C.ALESSIO MAZZOLA, Mattia; Boccalini, Sara; Fisci, Erica; ROLLA BIGLIANI, Claudia; Tagliafico, Alberto; Martinoli, Carl

Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease : a systematic review and meta-analysis

Objectives: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD). Methods: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2. Results: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86–92 %), the pooled specificity 72 % (63–79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90–97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83–90 %). Specificity of whole-heart acquisition mode (78 %, 72–84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45–69 %). Specificity at 3 T (83 %, 69–92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60–76 %). Risk of bias and concerns regarding applicability were low. Conclusions: Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance. Key Points: • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90–97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72–84 %), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA

Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease : a systematic review and meta-analysis

Objectives: To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD). Methods: Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2. Results: Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86\u201392 %), the pooled specificity 72 % (63\u201379 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p 65 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90\u201397 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83\u201390 %). Specificity of whole-heart acquisition mode (78 %, 72\u201384 %) was higher (p = 0.006) than that of targeted mode (57 %, 45\u201369 %). Specificity at 3 T (83 %, 69\u201392 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60\u201376 %). Risk of bias and concerns regarding applicability were low. Conclusions: Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance. Key Points: \u2022 MRCA sensitivity and specificity for CAD are below those of CTA. \u2022 Contrast administration increased sensitivity to 95 % (90\u201397 %), comparable with that of CTA. \u2022 Whole-heart mode increased specificity to 78 % (72\u201384 %), comparable with that of CTA. \u2022 Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. \u2022 Whole-heart contrast-enhanced protocols are the best approach for MRCA

Nerves of the Hand beyond the Carpal Tunnel.

Imaging studies including ultrasound (US) and magnetic resonance imaging may be required to evaluate the median nerve in patients with suspected carpal tunnel syndrome. However, the radial and ulnar nerves contribute to sensory and motor innervations to the hand as well. Compressive, traumatic, and iatrogenic events may damage the small terminal branches of these nerves. In the hand, US is able to identify injuries of the median, ulnar, radial nerve, and terminal branches. This article presents the role of imaging to evaluate the nerves of the hand with an emphasis on US. Due to its high-resolution capabilities, US is useful to determine the location, extent, and type of nerve lesion. Moreover, US is useful for a postsurgical assessment. The anterior interosseous nerve, Guyon's tunnel syndrome, and Wartenberg's syndrome are also described

Diffusion tensor magnetic resonance imaging of the normal breast: reproducibility of DTI-derived fractional anisotropy and apparent diffusion coefficient at 3.0 T.

PURPOSE: Diffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTIderived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T. MATERIALS AND METHODS: This prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28-85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session. RESULTS: Mean ADC and FA for DTI sequences were, respectively, 1.92\ub10.30 and 0.32\ub10.09. Intra- and seinterobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15\% for ADC and 30\% for FA. Repeatability with \u3b1=0.05 was 0.37 710-3 mm(2)/s for ADC and 0.112 for FA. CONCLUSIONS: ADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA